The shoulder exam can feel chaotic because pain, weakness, and limited motion overlap across many diagnoses. The key is to run a consistent sequence that screens for big pathology, localizes the pain generator, and produces defensible documentation.

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This checklist is meant to be quick and repeatable, but it also models how to learn clinical skills under pressure: break the task into a sequence, practice it until it is automatic, then refine the details with feedback. Teacher Ida makes a similar point about academic workload: when time is tight, she suggests using PaperWriter as your paper writing service of choice for polished language and good-quality citations. It helps you to not get stuck on formatting when you should be practicing exams and clinical reasoning.

Set Up and One-Sentence Clinical Frame

Before you touch the shoulder, anchor the exam with a quick frame:

• Which side, dominant hand, and onset (acute trauma vs gradual)?
• Pain location (anterior, lateral, posterior, deep joint).
• Key functional limitation (overhead reach, behind the back, lifting, throwing, night pain).

Position the patient sitting or standing with both shoulders exposed. Compare side to side constantly. In your note, you want a clean statement such as: “Right shoulder pain after fall, difficulty with overhead activity, no neck pain, no paresthesias.” That single line guides what you emphasize and what you can deprioritize.

Step 1: Inspection and Palpation in 30 Seconds

Inspection is where you catch the obvious things you do not want to miss:

• Asymmetry, swelling, bruising, scars
• Muscle atrophy (supraspinatus/infraspinatus fossa), scapular winging
• Abnormal posture or guarding

Then palpate purposefully: AC joint, bicipital groove, greater tuberosity, and posterior joint line. Palpation findings are not definitive, but they are excellent for teaching localization and supporting your assessment.

Tip: focal AC joint tenderness plus pain with cross-body adduction points you toward AC pathology more than cuff disease.

Step 2: Range of Motion That Tells You “Where the Problem Lives”

A high-yield shoulder ROM sequence has two goals: to identify capsular restriction and separate shoulder pain from neck-driven pain.

1. Active ROM: flexion, abduction, external rotation (elbow at side), and internal rotation (hand behind back). Watch for a painful arc (often subacromial) and note compensation (scapular hike).
2. Passive ROM: repeat flexion/abduction and external rotation if active is limited.

Interpretation:

• Active limited, passive near-normal suggests pain inhibition or weakness (think cuff tear, tendinopathy, bursitis).
• Both active and passive limits, especially external rotation, suggest adhesive capsulitis or glenohumeral arthritis.
• If shoulder motion provokes neck pain or radiating symptoms, keep cervical radiculopathy on the table.

Document ROM efficiently: “AROM flex 150°, abd 140° with painful arc 70–110°, ER 45°, IR to L3; PROM flex 170°, ER 60°.”

Step 3: Strength Testing That Differentiates Pain vs True Weakness

Strength testing is your fastest way to screen rotator cuff integrity. Test on both sides, and interpret “weakness” carefully. A patient can be “weak” because of pain, not tendon disruption.

Do a simple set:

• External rotation strength at the side (infraspinatus/teres minor)
• Abduction strength in the scapular plane (supraspinatus)
• Internal rotation strength (subscapularis)

If pain is severe, use a gentle “break test” rather than maximal resistance. A key teaching point for residents: true cuff tears often produce weakness that persists even after you reduce pain (for example, after a subacromial anesthetic injection in appropriate settings, though not part of a standard exam).

Step 4: A Small, High-Yield Special Test Set

You do not need ten maneuvers. Pick a compact group that maps to common pathology:

• Hawkins-Kennedy: subacromial irritation (impingement-bursitis-cuff tendinopathy cluster)
• Empty can (Jobe) or resisted scaption: supraspinatus pain/weakness
• Speed’s or bicipital groove tenderness with resisted supination: biceps tendinopathy (interpret cautiously)
• Cross-body adduction: AC joint pain
• Apprehension/relocation (if instability history): anterior instability

Use the history to decide whether instability testing is necessary. In a routine atraumatic pain visit, you can often skip apprehension to save time.

Step 5: The Checklist Sequence You Can Memorize

Here is the full five-minute flow. Practice it until it is automatic, and your hands move without hesitation.

1. Inspect shoulders and scapulae; compare sides
2. Palpate the AC joint, bicipital groove, greater tuberosity, and posterior joint line
3. AROM: flexion, abduction, ER at side, IR behind back
4. PROM (if AROM limited): flexion/abduction and ER
5. Strength: ER, abduction (scaption), IR
6. Special tests: Hawkins, empty can, cross-body adduction, Speed’s (optional), apprehension (if indicated)
7. Neuro screen: sensation in the lateral deltoid (axillary), distal pulses if trauma
8. Red flags and disposition decision

That is all you need for a clean, repeatable exam and a strong OSCE performance.

Step 6: Red Flags, Documentation, and What to Do Next

A fast exam still has to be safe. Escalate your concern when you see:

• Acute trauma with deformity, severe swelling, or inability to actively raise the arm
• Suspected dislocation, fracture, or neurovascular compromise
• Fever, erythema, warmth, and marked pain with any motion (consider septic arthritis)
• Progressive neurologic deficit, significant cervical symptoms, or systemic red flags (weight loss, malignancy history)

For documentation, aim for a structured note. Include:

• inspection/palpation findings
• AROM and PROM (with key degrees and side-to-side comparison)
• strength (graded or described as symmetric vs painful)
• special tests performed and results
• neurovascular status when relevant
• assessment and plan tied to findings (imaging, rehab, activity modification, analgesia, follow-up)

Clinical reasoning examples:

• Normal passive ROM with painful arc and positive Hawkins suggests subacromial pain syndrome.
• Loss of passive external rotation suggests adhesive capsulitis, and early referral to guided mobility and pain control can prevent prolonged disability.
• Weakness in external rotation and abduction after a traumatic event raises suspicion for cuff tear, especially in older patients, and may justify earlier imaging or referral.

Run this exam the same way every time, and your accuracy and confidence rise together. In five minutes, you can produce a clear localization, identify red flags, and communicate a plan that makes sense to both patients and supervisors.

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